DESCRIPTION: Heavy smokers account for a disproportionately high share of the morbidity and mortality connected with smoking and are more likely to request assistance in dealing with their tobacco addiction, especially the physiological aspects of cessation. Nicotine replacement therapy (NRT), especially delivered through the transdermal patch, counteracts some of the withdrawal effects of smoking cessation; however, NRT alone is not sufficient to produce long-term success in smoking cessation. Standard adjuvant materials that accompany the patch are booklets describing how a person should quit. Given that the majority of heavy smokers are in low socioeconomic strata or in blue-collar occupations, the written materials may not be the most appropriate method of learning. Indeed, evidence suggests that visual learning strategies are more likely to be used by this group. Thus, the investigators propose to develop video tape, adjuvant to NRT, to increase quit rates among heavy smokers. The specific aims of this proposed project are to: 1) develop a video adjunct to nicotine replacement therapy (NRT) that is built on input from heavy smokers; 2) test the efficacy of NRT plus video versus NRT plus standard materials in achieving 6 month abstinence among heavy smokers in a randomized controlled trial; and 3) assess the cost-effectiveness of NRT plus video intervention versus NRT plus standard materials. This 42 month study will begin with a qualitative study to develop the tailored video for the heavy smokers (smokers who smoke 25 or more cigarettes per day) participating in the project. The initial basis for development will be elicitation interviews with heavy smokers and former heavy smokers (who quit within the past year). Content analysis of the elicitation interviews will identify the major issues, concerns, barriers, and facilitators for quitting among this group, as well as potential messages that may be useful in convincing others to quit. Results from the elicitation interviews will be explored in a series of focus groups where standard focus group questioning will be conducted and trigger films and video rough-cuts will be discussed. Following the development of the intervention video and other materials, a randomized, controlled trial will be conducted in which one arm of the study receives NRT with the video intervention and the other arm receives NRT with standard, available materials. The primary outcome is self-reported six month continuous smoking cessation, verified by expired CO at 6 months post-cessation. A second primary outcome is the cost-effectiveness of the intervention. Secondary outcomes include end of treatment cessation, number of quit attempts, use of NRT, and use of the video intervention. With an anticipated difference of 10 percentage points between the two arms, a .05 level of significance, and 80 percent power, approximately 200 heavy smokers will need to be recruited to each arm of the study.